Carbon Ion Radiotherapy for Primary Glioblastoma - Full Text View

Sponsor:	University Hospital Heidelberg
Information provided by:	University Hospital Heidelberg
ClinicalTrials.gov Identifier:	NCT01165671

Purpose

Treatment standard for patients with primary glioblastoma (GBM) is combined radiochemotherapy with temozolomide (TMZ). Radiation is delivered up to a total dose of 60 Gy using photons. Using this treatment regimen, overall survival could be extended significantly however, median overall survival is still only about 15 months.

Carbon ions offer physical and biological advantages. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increase relative biological effectiveness (RBE), which can be calculated between 2 and 5 depending on the GBM cell line as well as the endpoint analyzed. Protons, however, offer an RBE which is comparable to photons.

First Japanese Data on the evaluation of carbon ion radiation therapy showed promising results in a small and heterogeneous patient collective.

In the current Phase II-CLEOPATRA-Study a carbon ion boost will be compared to a proton boost applied to the macroscopic tumor after surgery at primary diagnosis in patients with GBM applied after standard radiochemotherapy with TMZ up to 50 Gy. In the experimental arm, a carbon ion boost will be applied to the macroscopic tumor up to a total dose of 18 Gy E in 6 fractions at a single dose of 3 Gy E. In the standard arm, a proton boost will be applied up to a total dose 10 Gy E in 5 single fractions of 2 Gy E.

Primary endpoint is overall survival, secondary objectives are progression-free survival, toxicity and safety.

Condition	Intervention	Phase
Primary Glioblastoma	Radiation: Carbon Ion Radiotherapy Radiation: Proton Radiotherapy	Phase II

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Randomized Phase II Study Evaluating a Carbon Ion Boost Applied After Combined Radiochemotherapy With Temozolomide Versus a Proton Boost After Radiochemotherapy With Temozolomide in Patients With Primary Glioblastoma

Resource links provided by NLM:

MedlinePlus related topics: Cancer

U.S. FDA Resources

Further study details as provided by University Hospital Heidelberg:

Primary Outcome Measures:

Overall Survival [ Time Frame: 12 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Progression-free Survival [ Designated as safety issue: Yes ]
Toxicity [ Designated as safety issue: Yes ]

Estimated Enrollment:	150
Study Start Date:	July 2010
Estimated Primary Completion Date:	June 2014 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Experimental Arm Carbon Ion Radiotherapy to the Macroscopic Tumor 6 x 3 Gy E up to 18 Gy E	Radiation: Carbon Ion Radiotherapy Carbon ion Radiotherapy up to 18 Gy E in 3 Gy E fractions to the macroscopic tumor
Active Comparator: Standard Arm Proton Radiotherapy to the Macroscopic Tumor 5 x 2 Gy E up to 10 Gy E (Standard dose) applied after 48-52 Gy photon radiotherapy	Radiation: Proton Radiotherapy Proton Radiotherapy up to 10 Gy E in 2 Gy E fractions to the macroscopic tumor

Detailed Description:

Study design

The purpose of the trial is to compare a carbon ion boost to a proton boost delivered to the macroscopic tumor in combination with combined radiochemotherapy with TMZ in patients with primary GBM.

The aim of the study is to compare overall survival as a primary endpoint, and progression free survival, toxicity and safety as secondary endpoints.

Focus of the analysis is to evaluate the change in overall survival and local control by carbon ion radiotherapy. Therefore, the aim of the trial is to evaluate the improvement in outcome due to effect of the altered biology of carbon ions on GBM. Chemotherapy with TMZ is considered standard treatment and is administered continuously as it would be applied in standard patient care outside any trial.

Trial Design The trial will be performed as a single-center two-armed randomized Phase II study.

Patients fulfilling the inclusion criteria will be randomized into two arms:

Arm A - Experimental Arm Carbon Ion Radiation Therapy as a Boost to the macroscopic tumor Total Dose 18 Gy E, 6 fractions, 3 Gy E single dose

Arm B - Standard Arm Proton Radiation Therapy as a Boost to the macroscopic tumor Total Dose 10 Gy E, 5 fractions, 2 Gy E single dose

Standard chemotherapy with TMZ will be continued during the experimental and standard arm in conventional dosing of 75 mg/m2 per day.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

histologically confirmed unifocal, supratentorial primary glioblastoma
macroscopic tumor after biopsy or subtotal resection
indication for combined radiochemotherapy with temozolomide
prior photon irradiation of 48-52 Gy to the T2-hyperintense area, resection cavity, areas of contrast enhancement adding 2-3cm safety margin in combination with standard temozolomide
registration prior to photon RT or within photon RT allowing the beginning of particle therapy ≤ 4 days after completion of photon irradiation
beginning of study treatment (proton or carbon ion RT) no later than 12 weeks after primary diagnosis
age ≥ 18 years
Karnofsky Performance Score ≥ 60
adequate contraception.
Ability of subject to understand character and individual consequences of the clinical trial
Written informed consent (must be available before enrolment in the trial)

Exclusion Criteria:

refusal of the patients to take part in the study
previous radiotherapy of the brain or chemotherapy with DTIC or TMZ other than during the radiochemotherapy stated in the inclusion criteria
more than 52 Gy applied via photon-RT prior to particle therapy
time interval of > 12 weeks after primary diagnosis (neurosurgical intervention) and beginning of study treatment (proton or carbon ion RT)
Patients who have not yet recovered from acute toxicities of prior therapies
Clinically active kidney, liver or cardiac disease
Known carcinoma < 5 years ago (excluding Carcinoma in situ of the cervix, basal cell carcinoma, squamous cell carcinoma of the skin) requiring immediate treatment interfering with study therapy
Pregnant or lactating women
Participation in another clinical study or observation period of competing trials, respectively.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01165671

Contacts

Contact: Stephanie E Combs, MD	+49-6221-56-8202	stephanie.combs@med.uni-heidelberg.de
Contact: Jürgen Debus, MD Ph D	+49-6221-56-8201	juergen.debus@med.uni-heidelberg.de

Locations

Germany
University Hospital of Heidelberg, Department of Radiation Oncology	Recruiting
Heidelberg, Germany, 69120
Sub-Investigator: Stephanie E Combs, MD
Principal Investigator: Jürgen Debus, MD PhD

Sponsors and Collaborators

University Hospital Heidelberg

More Information

Additional Information:

Homepage Department of Radiation Oncology This link exits the ClinicalTrials.gov site

No publications provided by University Hospital Heidelberg

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Combs SE, Kieser M, Rieken S, Habermehl D, Jäkel O, Haberer T, Nikoghosyan A, Haselmann R, Unterberg A, Wick W, Debus J. Randomized phase II study evaluating a carbon ion boost applied after combined radiochemotherapy with temozolomide versus a proton boost after radiochemotherapy with temozolomide in patients with primary glioblastoma: the CLEOPATRA trial. BMC Cancer. 2010 Sep 6;10:478.

Responsible Party:	Prof. Dr. Dr. Jürgen Debus, Medical Director Department of Radiation Oncology, University Hospital of Heidelberg
ClinicalTrials.gov Identifier:	NCT01165671 History of Changes
Other Study ID Numbers:	CLEOPATRA, 2009-014668-21, ISRCTN37428883
Study First Received:	July 13, 2010
Last Updated:	July 30, 2010
Health Authority:	Germany: Federal Office for Radiation Protection

Keywords provided by University Hospital Heidelberg:

Primary Glioblastoma

Additional relevant MeSH terms:

Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors

Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue

ClinicalTrials.gov processed this record on February 09, 2012